Heather R Holt, DDS
Individual provider Active NPI General Practice Dentistry · Long Prairie, MN
NPI 1528624657 · NPPES record last updated Sep 8, 2021
Key facts
- NPI
- 1528624657
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D14173 (MN)
- Practice address
- 220 Lake St S Ste 103
Long Prairie, MN 56347-1548 - Phone
- (320) 533-4010
- Fax
- (320) 533-4020
- NPI assigned
- May 14, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190712000202 | MN | Order and Referring Only - Dentist |
3779818711 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prairie Family Dental | General Practice | Current |
Accepting new patients |
Locations
220 Lake St S
Ste 103
Long Prairie, MN 56347
Phone (320) 533-0240
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D14173 | MN | Yes |
Addresses
Primary practice location
220 Lake St S Ste 103
Long Prairie, MN 56347-1548
Mailing address
220 Lake St S Ste 103
Long Prairie, MN 56347-1548
Phone (320) 533-4010
Other providers in Long Prairie, MN
- Ceree E. George
- Bobbie Jo Marie Haagenson
- Christopher Allan Hagen
- Haven Road Recovery Center, LLC
- Haven Road Recovery Center, LLC
- Hometown Furniture Inc.
- Lynelle Thomas Howard
- Danielle Lee Kreemer
- Lakeland Dental P.L.L.C.
- Lakewood Health System
All providers in Long Prairie, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.